Overview
Work History
Signature
Identity Theft Victim’s Complaint and Affidavit
About You (the victim)
Declarations
About the Fraud
Documentation
About the Information or Accounts
Your Law Enforcement Report
Timeline
Generic

Lionnel Hargrove

Las Vegas,USA

Overview

10
10
years of professional experience

Work History

Field Sale, Professional

CIGNA Healthcare
01.1984 - 04.1994

Self-motivated, with a strong sense of personal responsibility.

  • Worked effectively in fast-paced environments.
  • Skilled at working independently and collaboratively in a team environment.
  • Proven ability to learn quickly and adapt to new situations.
  • Excellent communication skills, both verbal and written.
  • Worked well in a team setting, providing support and guidance.
  • Demonstrated respect, friendliness and willingness to help wherever needed.
  • Assisted with day-to-day operations, working efficiently and productively with all team members.
  • Passionate about learning and committed to continual improvement.
  • Worked flexible hours across night, weekend, and holiday shifts.
  • Managed time efficiently in order to complete all tasks within deadlines.
  • Organized and detail-oriented with a strong work ethic.
  • Paid attention to detail while completing assignments.
  • Used critical thinking to break down problems, evaluate solutions and make decisions.
  • Strengthened communication skills through regular interactions with others.
  • Adaptable and proficient in learning new concepts quickly and efficiently.
  • Learned and adapted quickly to new technology and software applications.
  • Proved successful working within tight deadlines and a fast-paced environment.
  • Developed and maintained courteous and effective working relationships.
  • Demonstrated strong organizational and time management skills while managing multiple projects.

Signature

As applicable, sign and date IN THE PRESENCE OF a law enforcement officer, a notary, or a witness. (21) I certify that, to the best of my knowledge and belief, all of the information on and attached to this complaint is true, correct, and complete and made in good faith. I understand that this complaint or the information it contains may be made available to federal, state, and/or local law enforcement agencies for such action within their jurisdiction as they deem appropriate. I understand that knowingly making any false or fraudulent statement or representation to the government may violate federal, state, or local criminal statutes, and may result in a fine, imprisonment, or both. Lionnel Hargrove 09/12/2025 Signature Date Signed (mm/dd/yyyy) (22) If you do not choose to file a report with law enforcement, you may use this form as an Identity Theft Affidavit to prove to each of the companies where the thief misused your information that you are not responsible for the fraud. While many companies accept this affidavit, others require that you submit different forms. Check with each company to see if it accepts this form. You should also check to see if it requires notarization. If so, sign in the presence of a notary. If it does not, please have one witness (non-relative) sign that you completed and signed this Affidavit. Lionnel Hargrove Notary Witness: Lionnel Hargrove Signature Lionnel Hargrove Printed Name 09/12/2025 (702) 849-2611 Date Telephone Number

Identity Theft Victim’s Complaint and Affidavit

  • A voluntary form for filing a report with law enforcement, and disputes with credit reporting agencies and creditors about identity theft-related problems. Visit ftc.gov/idtheft to use a secure online version that you can print for your records.
  • Before completing this form:
  • 1. Place a fraud alert on your credit reports, and review the reports for signs of fraud.
  • 2. Close the accounts that you know, or believe, have been tampered with or opened fraudulently.

About You (the victim)

  • Now
  • (1) My full legal name: Lionnel Hargrove
  • (2) My date of birth: 1959-09-22
  • (3) My Social Security number: 573-19-8526
  • (4) My driver’s license: NV 1601051416
  • (5) My current street address:
  • 4600 University Center Dr. 60
  • Las Vegas NV 89119 USA
  • (6) I have lived at this address since 2015-09-22
  • (7) My daytime phone: (702) 849-2611
  • My evening phone: (___) _________________
  • My email: lionnelhargrove@gmail.com
  • At the Time of the Fraud
  • (8) My full legal name was: Lionnel Hargrove
  • (9) My address was: 4600 University Center Dr. 60
  • (10) My daytime phone: (702) 849-2611 My evening phone: (___) _________________

Declarations

  • (11) I did not authorize anyone to use my name or personal information to obtain money, credit, loans, goods, or services — or for any other purpose — as described in this report.
  • (12) I did not receive any money, goods, services, or other benefit as a result of the events described in this report.
  • (13) I am willing to work with law enforcement if charges are brought against the person(s) who committed the fraud.

About the Fraud

  • (14) I believe the following person used my information or identification documents to open new accounts, use my existing accounts, or commit other fraud.
  • Name:
  • Address:
  • Phone Numbers: (___) _________________ (___) _________________ (___) _________________
  • Additional information about this person:

Documentation

  • (16) I can verify my identity with these documents:
  • A valid government-issued photo identification card (for example, my driver’s license, state-issued ID card, or my passport).
  • Proof of residency during the time the disputed charges occurred, the loan was made, or the other event took place (for example, a copy of a rental/lease agreement in my name, a utility bill, or an insurance bill).

About the Information or Accounts

  • (17) The following personal information (like my name, address, Social Security number, or date of birth) in my credit report is inaccurate as a result of this identity theft:
  • (A)
  • (B)
  • (C)
  • (18) Credit inquiries from these companies appear on my credit report as a result of this identity theft:
  • Company Name: Bank of America
  • Company Name: Credit Union
  • Company Name: First American Credit

Your Law Enforcement Report

  • (20) One way to get a credit reporting agency to quickly block identity theft-related information from appearing on your credit report is to submit a detailed law enforcement report (“Identity Theft Report”). You can obtain an Identity Theft Report by taking this form to your local law enforcement office, along with your supporting documentation. Ask an officer to witness your signature and complete the rest of the information in this section. It’s important to get your report number, whether or not you are able to file in person or get a copy of the official law enforcement report. Attach a copy of any confirmation letter or official law enforcement report you receive when sending this form to credit reporting agencies.
  • Select ONE:
  • I have not filed a law enforcement report.
  • I was unable to file any law enforcement report.
  • I filed an automated report with the law enforcement agency listed below.
  • I filed my report in person with the law enforcement officer and agency listed below.
  • Law Enforcement Department
  • State
  • Report Number
  • Filing Date (mm/dd/yyyy)
  • Officer’s Name (please print)
  • Officer’s Signature
  • Badge Number
  • Phone Number
  • Did the victim receive a copy of the report from the law enforcement officer? Yes
  • Victim’s FTC complaint number (if available):

Timeline

Field Sale, Professional

CIGNA Healthcare
01.1984 - 04.1994
Lionnel Hargrove